Just as we all benefit when we all are better informed about health, everyone involved in the health care of older adults can benefit from learning to think more like a geriatrician. 

This means keeping certain guiding principles in mind. It also means watching for certain common pitfalls, when it comes to the medical care of aging adults.

In 2016, the most important principles of geriatric care were distilled down to a “4 Ms” model for age-friendly care:

• Mentation: preventing, identifying, treating and managing mental health and cognitive conditions
• Mobility: helping older adults avoid falls and remain mobile, for maximum independence
• Medication: optimizing medication use to avoid harm and improve health
• What Matters: ensuring that medical care addresses what matters most to an older person and is aligned with their specific health goals and care preferences

Problems in aging health are especially common when it comes to medications. So geriatricians always pay attention to what drugs have been prescribed, and why. Then we often improve an older person’s health by suggesting changes to their medications.

In this article, I’ll share five geriatrics medication safety truths that I often find myself explaining to families. They are what I always keep in mind as I do my work, as they are the foundation for better prescribing in aging adults, as well as for checking an older adult’s medications for safety and appropriateness.

I tell people these medication safety truths because I know that most older adults will not have their medications regularly reviewed by a geriatrician or geriatric pharmacist. 

But with the right knowledge, you’ll be better prepared to ask your doctors the right questions. This can help them address common oversights, and can improve the safety of your medications.

Here’s what you should know, along with tips on what you can do:

1. Fewer medications is often safer

That’s because the more medications an older adults takes, the greater the chance of side-effects, interactions, and emergencies due to adverse events.

(A side-effect would be something like dry mouth from a depression drug. An adverse event is something like internal bleeding due to taking a blood-thinner.) 

Fewer medications also means lower drug costs and pill burden, which means an older person is more likely to keep taking their medications in the long run. Now, after careful review we sometimes find that it’s not possible to reduce the number of medications. But it’s still a good goal to keep in mind.

What you can do: Periodically tell the doctors that you’d prefer to be on fewer medications if possible. Ask the doctors – or a pharmacist — to help you identify any medications that could perhaps be eliminated. In some cases, it may be possible to treat a problem with non-drug therapies instead. (See below.)

2. Non-drug treatments are often safer and can be equally effective

These include psychotherapy, exercise and social activities for depression, physical therapy for pain, watchful waiting for minor problems, or behavior management for dementia agitation. Although these may take more effort to implement initially, they often are better for older adults and families in the long run. 

But many doctors are used to recommending prescription medication as a default. So don’t assume they will tell you about non-drug treatment options automatically; like all busy people they tend to fall back on their habits. 

What you can do: Whenever a doctor proposes a prescription medication treatment for a given problem, be sure to ask about non-drug treatment options too. The doctor should be happy to review these once you’ve expressed your interest.

3. Medications often get “forgotten”

When I review an older person’s medications, I often find medications that seem to have been “forgotten.” It might be a drug that was initially prescribed in the hospital but isn’t still needed. Or it might be a starter dose of a medication that perhaps should’ve been increased (or stopped, if a problem such as depression has improved).

This happens in part because many medical visits are relatively short, which can make it hard for clinicians to carefully review all medications to make sure they are all needed, and at the right dosage. So don’t assume that a renewed prescription means a doctor has carefully thought through the need for the medication. It’s much better to plan on actively reviewing the need for every medication, on at least a yearly basis.

What you can do: If a medication was recently added during a hospitalization, make sure the primary care doctor checks up on it at a later follow-up visit. You can also request a comprehensive medication review, which usually means that all medications are re-evaluated for appropriateness and safety.

4. Doctors often prescribe medications that are on the Beer’s list

This is a list of medications that older adults should avoid or use with caution. Despite ongoing efforts to make sure that all doctors are trained to modify healthcare as needed for older adults, it still remains common for these medications to be prescribed, without documentation that the benefits and risks have been discussed with the older patient.

In general, older adults and their families should not assume that their doctors have carefully thought through the risks of using these drugs in an older person. It’s much safer to plan on nudging the doctor to identify and reconsider these drugs. Pharmacists are also a good resource, for spotting these drugs.

What you can do: Check and see if any of your parent’s medications are on the Beer’s list. (It’s often easiest to open the Beer’s list on a computer and use the search function to see if any of your parent’s medications are on the list.) If you discover that your parent is taking medications that are on the Beer’s list, you can use my video below as a guide.

5. When considering a particular medication, the goal is to properly weigh the pros and cons

It’s not ideal for an older person to be taking a medication on the Beer’s list. But sometimes it makes sense, when the likely pros outweigh the likely downsides.

The key is to be choosing medications intentionally and judiciously.

In geriatrics, we often call this “balancing the benefits and burdens.”

Burdens include consistent downsides (like cost or hassle) which definitely affect an older person, as well as the risks (like side-effects or interactions) which will only affect a minority of aging adults. 

Risks can often be reduced with a lower dosage of a medication. For instance, studies suggest that for most people, a medium dose of cholesterol medication is almost as beneficial as a high dose, but it causes problems less often. Also, bear in mind that doctors may not understand how much cost, hassle, or burden a medication causes, unless you tell them.

What you can do: When considering starting or continuing a medication, plan on asking the doctor to clarify the likely benefit, along with the risk. The likely benefit is often smaller than people realize, as is explained in this excellent article about medication.

Remember, healthcare works best when it’s a partnership between patients, family caregivers, and doctors. 

By understanding best practices in prescribing for older adults, and by learning about common pitfalls in medication safety, you’ll be better able to ensure you’re getting the medications you need, and avoiding medications you don’t need.

You can also learn more about eliminating unneeded medications here: Deprescribing: How to Be on Less Medication for Healthier Aging.

How might we help a sick older person have a better end-of-life experience? Planning for future health crises and end-of-life situations — a process known as advance care planning — is certainly important.

But, not every health crisis can be completely planned for. And it’s often hard, in the moment, for family members and doctors to figure out how to honor a person’s wishes. Below, I’d like to share a true story about a dangerously ill older woman, who wasn’t on hospice but said she didn’t want to go to the hospital.

The case: To ER or not to ER?

As I puttered around my house one Saturday morning, my pager went off. “Dr. Kernisan? This is Tina from the nursing home. We’re calling you about Mrs. F. She’s 78 and has a diagnosis of advanced lymphoma. She’s been anemic and just got a blood transfusion again a few days ago. She’s now very weak, pale, and her blood pressure is low. Her poop looks red.”

Although by then I had fired up my computer and was remotely logging in to Mrs. F’s chart, this sounded like a no-brainer. I didn’t know Mrs. F personally, but that weekend I was on call by phone for our medical group’s nursing home. From the brief description, Mrs. F sounded critically ill, and was probably bleeding internally. She needed hospitalization ASAP.

“But she says she doesn’t want to go to the ER,” the nurse continued. “She says she hates the hospital and wants to stay in the nursing home.”

This stopped me short. “Is there an advance directive in her chart? Is she usually able to make medical decisions?” I asked.

“It says she is DNR, but it looks like that was just decided a few weeks ago. It says transfer to the hospital is ok. It looks like she’s been offered hospice, but she hasn’t signed up for it. She does usually make medical decisions.”

I frowned at my computer screen, scrolling through Mrs. F’s chart. She definitely sounded dangerously ill. She had to be hospitalized, probably in the Intensive Care Unit.

Or did she?

The challenge: Difficult choices at the (possible) end of life

The modern hospital is a miraculous place. Today, doctors routinely save people from medical disasters that were unstoppable just 25 years ago. But this magic often comes at a cost. Most people find the hospital to be, at best, uncomfortable and stressful. And being in the hospital always comes with a small risk of complications, such as falls, extra infections, or medication mishaps.

Still, most of the time, the benefits outweigh the burdens and risks. But this balancing of pros and cons gets trickier when a person is terminally ill, like Mrs. F. Even though her cancer was advanced, and she had decided she didn’t want CPR if her heart suddenly stopped, her chart showed that she’d been accepting fairly intensive medical treatments. This was surely helping to keep her alive.

Yet it also sounded like she was starting to get tired of the medical merry-go-round, and was perhaps considering a transition to hospice. I decided to suggest that she go to the ER for more evaluation. Perhaps she could get a blood transfusion, and then we’d see if she could return to the nursing home at the end of the day.

She agreed. An hour later, the ER doctor called me with an update: “She’s definitely having some bleeding from her bowels or stomach. Her family is here. I’ve told them she has to go to the Intensive Care Unit, and she’s agreed to go.”

I felt troubled. I had full confidence in the ER’s medical assessment. If the hospital team stabilized her and found the cause of her bleeding, she’d probably live longer. Yet she’d said earlier that she didn’t want to be in the hospital. No matter what we did, Mrs. F. probably didn’t have much time left. Yet now she was off to intensive care. Was that the only option we could offer?

The solution: The power of offering alternatives

I took a deep breath. “Well, if she wants to go to the ICU, she should. But I noticed in the chart that she’s considered hospice. We should be sure that she and her family know that there’s an alternative to the ICU. If you tranfuse her in the ER now, she’ll probably feel better than she does now. Then we can take her back to the nursing home tonight, where she can be more comfortable.”

“But what if she keeps bleeding? What if she gets worse? She could die,” protested the ER doctor.

“That’s true,” I agreed. “If what’s most important to her is not dying, she should go to the ICU. But if what’s most important to her is to not be in the hospital, we can probably keep her comfortable and peaceful in the nursing home, even if she’s bleeding.”

There was a pause on the other end. “You’d better explain this option to her family,” said the ER doctor. A moment later, Mrs. F’s daughter was on the line. “This decision isn’t mine to make,” she said after listening to me. She sounded scared. “Let me put my mother on the phone.”

A few moments later, it was the daughter, not Mrs. F, on the line with me again. Now she sounded tearful. “She said she wants to go back to the nursing home.” I tried to confirm that Mrs. F. had understood what that might mean, but the daughter cut me off. “I don’t think she wants to have a long discussion about this. She says she wants to go back.”

Mrs. F. was tranfused two units of red blood cells in the ER for her comfort and stability, and went back to the nursing home later that evening.

The nurses didn’t call me about her that night, nor the following day, which was Sunday.

Mrs. F. died on Monday, in the nursing home. By then her usual primary care doctor was back covering her care. He told me that Mrs. F. had been weak and tired but otherwise comfortable. “I’m glad you recommended hospice-style care in the nursing home to her,” he said.

“I didn’t recommend anything,” I said. “All I did was let her know of an alternative.”

My take-home points for family caregivers

Doctors are trained to save lives, and for most people, this is a wonderful thing. But for some people, staying alive as long as possible is no longer the highest priority. If this is the case for your loved one, consider asking doctors to discuss alternatives. Often it’s possible to come up with another plan of care that may be a better fit for a sick person’s needs.

Even those people who have not signed up for hospice will sometimes prefer less medically-intensive care. If available, a consultation with a geriatrician or palliative care team can help identify alternative options.

In fact, counseling families to help them understand all their options is something I regularly do as part of the Helping Older Parents Membership, so if you’re interested in accessing that type of guidance from me, learn more here: About Dr. Kernisan’s Helping Older Parents Membership Program.

Have you had difficulty figuring out how to honor an older person’s healthcare wishes? Have you struggled with planning for end-of-life situations? I’d love to hear from you in the comments section!

Have you been told that you — or an older person you care about — has kidney disease?

If so, you’re not alone: kidney disease is very common in older adults. Almost everyone’s kidney function declines at least a little with aging, with actual chronic kidney disease affecting an estimated 35% of people over age 65.

It’s also fairly common for older adults to develop an “acute kidney injury,” which means the kidneys suddenly start working less well. This often happens during an illness, dehydration, infection, or hospitalization.

Fortunately, in most cases, acute kidney injuries improve, and chronic kidney disease remains fairly manageable, with only a minority of older adults progressing to needing dialysis.

But kidney disease is still important to recognize and monitor, because it can affect medication safety, blood pressure, fluid balance, and overall health.

In this article, I’ll cover what older adults and families should know about kidney disease in aging.

What Do the Kidneys Do?

Most people are born with two kidneys, located in the back of the body, just below the rib cage. Their main job is to continuously filter the blood and produce urine.

But the kidneys do much more than make urine. They are involved in many important body functions, including:

• Regulating fluid levels in the body
• Helping control blood pressure
• Keeping electrolytes such as sodium, potassium, calcium, chloride, and magnesium in balance
• Regulating the acidity, or pH, of the blood
• Removing waste products from the bloodstream
• Helping stimulate red blood cell production through a hormone called erythropoietin
• Helping convert vitamin D into its active form
• Helping metabolize and excrete certain medications

Each kidney contains millions of tiny filtering units called nephrons. Each nephron includes a glomerulus, which starts the filtering process, and a tubule, which reabsorbs needed substances and helps remove waste.

Normally, healthy kidneys keep important things like blood cells, large proteins, and glucose in the body. That’s why, under normal circumstances, those substances should not be found in significant amounts in the urine.

How Kidney Function Is Measured

Kidney function is usually checked with blood tests that are part of a basic metabolic panel.

One of the most important numbers is the eGFR, or estimated glomerular filtration rate. This estimates how well the kidneys are filtering the blood.

A normal adult filtration rate is usually around 90 to 120 mL/min. This reflects the function of both kidneys together.

Other common kidney-related blood test results include:

• Creatinine: This is a waste product that tends to rise when kidney function declines. A typical normal range is about 0.7 – 1.3 mg/dL, although this varies by lab and by the person’s muscle mass.
• BUN, or blood urea nitrogen: This is another waste-related marker. A typical normal range is about 6 – 20 mg/dL.

It’s important to know that creatinine is affected by muscle mass. For instance, a petite older woman with low muscle mass may normally have a creatinine of 0.6. If it rises to 1.1, that may represent a meaningful decline in kidney function, even though 1.1 might look “normal” on many lab reports. (This is why it’s always useful to look at past lab results!)

If kidney dysfunction becomes more significant, other abnormalities may appear, such as high potassium levels or excess acidity in the blood.

Chronic Kidney Disease vs Acute Kidney Injury

There are three main kidney issues that commonly arise in medical care.

Chronic kidney disease

Chronic kidney disease (CKD) means there is long-term, ongoing evidence of kidney damage or reduced kidney function.

CKD is usually defined as either:

• Evidence of kidney damage, such as albumin or protein in the urine, or
• A filtration rate (eGFR) below 60 mL/min for at least three months

Chronic kidney disease is often caused by long-term damage from conditions such as high blood pressure or diabetes.

Acute kidney injury

Acute kidney injury means kidney function suddenly worsens over hours or days.

This can happen because of:

• Dehydration
• Low blood pressure
• Blood loss
• Infection
• Certain medications
• Urine blockage, such as from urinary retention or an enlarged prostate

Acute kidney injury is often reversible if the underlying problem is found and corrected.

Acute on chronic kidney disease

Sometimes an older adult already has chronic kidney disease and then develops an acute kidney injury on top of it. This is called acute-on-chronic kidney disease.

For example, someone may have mild chronic kidney disease for years, then become dehydrated during an illness and have their kidney function suddenly worsen.

Symptoms of Kidney Disease in Older Adults

One important thing to know is that mild to moderate kidney dysfunction usually causes no symptoms.

Many older adults with chronic kidney disease feel completely normal. Their kidney disease may only be noticed because of routine blood tests.

Even a GFR in the 50s often causes no symptoms. Kidney function can sometimes get significantly lower before a person feels unwell.

However, more severe kidney dysfunction can cause symptoms and complications, including:

• Fluid overload, such as significant leg swelling
• Worsening heart failure symptoms
• High potassium levels, which can cause muscle weakness, cramps, spasms, or irregular heart rhythms
• Uremia, which means waste products are building up in the blood

Significant uremia tends to cause symptoms. Symptoms of uremia can include:

• Confusion
• Drowsiness
• Itching
• Nausea
• Loss of appetite
• Vomiting

In older adults, new or worsening confusion is especially important to evaluate. This is often called delirium, and kidney dysfunction can be one possible cause or contributor.

Stages of Chronic Kidney Disease

Chronic kidney disease is often described in stages based on eGFR.

The general kidney function stages are:

Stage	eGFR	Description
G1	90 or higher	Normal or high kidney function
G2	60 to 89	Mildly decreased kidney function
G3a	45 to 59	Mildly to moderately decreased kidney function
G3b	30 to 44	Moderately to severely decreased kidney function
G4	15 to 29	Severely decreased kidney function
G5	Less than 15	Kidney failure

It’s important to understand that most older adults with chronic kidney disease do not progress to stage 5 kidney failure, which may require dialysis to control fluids and electrolytes.

Many people remain in the mild or moderate stages for a long time. In these cases, the main focus is usually monitoring kidney function, protecting the kidneys, avoiding medication-related harm, and managing contributing conditions.

What Causes Kidney Disease in Older Adults?

The most common causes of chronic kidney disease in older adults are long-term damage from:

• High blood pressure
• High blood sugar, especially diabetes

These conditions can gradually damage the small blood vessels and filtering structures in the kidneys.

Other causes or contributors include:

• Chronic use of medications that can stress the kidneys, such as NSAIDs
• Kidney infections or other serious infections
• Autoimmune diseases
• Blocked urine flow
• Kidney stones
• Tumors
• Enlarged prostate causing urinary retention
• Smoking
• Obesity
• Other conditions that increase inflammation

Aging itself is also associated with a gradual decrease in kidney function. One estimate is that GFR declines by about 1% per year with age, or about 8 mL/min per decade starting in midlife.

This doesn’t mean kidney disease should be ignored or dismissed as “just aging.” But it does mean that some decline in kidney filtration is common in later life.

Why It’s Important to Know If You Have Chronic Kidney Disease

Because chronic kidney disease (CKD) often causes no symptoms, it may not seem urgent. But it’s still important to know about it.

If you have CKD, you and your health providers may need to take steps to:

• Avoid or minimize medications that can worsen kidney function
• Adjust doses of certain medications
• Monitor kidney function over time
• Control blood pressure
• Manage diabetes or high blood sugar
• Check for protein or albumin in the urine
• Reduce the risk of progression
• Watch for complications such as electrolyte problems or anemia

One common medication group to be careful with is NSAIDs, or non-steroidal anti-inflammatory drugs. These include medications such as ibuprofen and naproxen.

NSAIDs can be useful in some situations, but they can stress the kidneys, especially in older adults who already have CKD, dehydration, heart failure, or are taking certain blood pressure medications.

How Kidney Disease Is Evaluated

Kidney dysfunction is often first noticed on routine bloodwork, especially a basic metabolic panel.

If kidney function looks abnormal, the next steps depend on several factors:

• How low the eGFR is
• Whether creatinine and BUN are elevated
• Whether the change appears sudden or gradual
• Whether the person is currently ill
• Whether there are symptoms such as dehydration, infection, low blood pressure, or urinary problems
• The person’s past medical history
• Current medications

Health providers usually try to determine:

• What stage of kidney disease is present
• Whether the problem looks acute, chronic, or acute-on-chronic
• Whether there is albumin or protein in the urine
• What is the likely underlying cause
• Whether the cause can be treated or better managed

A medication review is especially important. Sometimes a medication is contributing to the kidney problem, or a medication dose may need to be adjusted because kidney function has declined.

Hydration status also matters, especially in frail older adults or those who have recently been ill.

In some cases, the best next step may simply be to repeat the blood test in one to two weeks, especially if the abnormality is mild or if dehydration or illness may have been involved.

Additional tests may include:

• A more detailed urinalysis
• Urine testing for albumin or protein
• Microscopic examination of the urine
• Kidney ultrasound
• Other specialized blood or urine tests, depending on the situation

When to See a Kidney Specialist

Kidney specialists are called nephrologists.

Much of the evaluation and management of mild-to-moderate chronic kidney disease can be handled in primary care. But a nephrology referral may be especially important if:

• eGFR is less than 30 mL/min
• Kidney function is declining quickly
• There is a very high level of protein in the urine
• There is blood in the urine that appears to come from the kidney’s filtering structures
• The diagnosis is unclear
• Advanced kidney disease is approaching and dialysis or transplant planning may need to be discussed

A primary care clinician can help determine when a nephrology referral is appropriate.

How Chronic Kidney Disease Is Managed

The main goals of chronic kidney disease management are to protect remaining kidney function, reduce progression, and prevent complications.

Common management steps include:

1. Control blood pressure

High blood pressure can damage the kidneys over time. Blood pressure control is one of the most important parts of protecting kidney function. (See below for more on which BP medications are especially good for the kidneys.)

2. Avoid medications that stress the kidneys

NSAIDs such as ibuprofen and naproxen can worsen kidney function in some people, especially when used regularly or during dehydration or illness.

Other medications may also need caution or dose adjustment, depending on kidney function.

3. Treat the underlying cause when possible

If diabetes, high blood pressure, urinary obstruction, infection, or another condition is contributing, managing that condition is key.

4. Manage blood sugar

High blood sugar can damage the kidneys over time. For people with diabetes, glucose management is an important part of kidney protection.

5. Check for albumin in the urine

Albumin in the urine can be a sign of kidney damage. It also helps health providers estimate the risk of kidney disease progression and decide which treatments may be helpful.

6. Consider kidney-protective medications when appropriate

For people with CKD and albuminuria, certain medications have been shown to slow progression in many cases.

These may include:

• ACE inhibitors
• Angiotensin receptor blockers, also called ARBs
• SGLT2 inhibitors

ACE inhibitors and ARBs are commonly used for blood pressure control. SGLT2 inhibitors were originally developed for diabetes, but they have also been found to have kidney-protective effects in certain people with chronic kidney disease.

As always, whether these medications are appropriate depends on the person’s overall health, lab results, blood pressure, medication list, and goals of care.

What Happens in Kidney Failure?

Kidney failure generally refers to very advanced kidney dysfunction, often when eGFR is around 15 mL/min or lower.

At that stage, the kidneys may no longer be able to adequately remove fluid, waste products, and excess electrolytes from the body. Severe kidney failure can eventually lead to death unless kidney function is replaced or managed in another way.

The main treatment options for end-stage kidney disease include:

• Dialysis
• Kidney transplant
• Conservative kidney management

What Is Dialysis?

Dialysis is a medical treatment that filters the blood to remove excess fluid and waste products.

There are two main forms:

• Hemodialysis: Blood is filtered through a machine. This is the most common form used in the United States.
• Peritoneal dialysis: The lining of the abdominal cavity is used to help filter waste and fluid.

Dialysis can be used temporarily in the hospital for severe acute kidney injury. It can also be used long-term for advanced chronic kidney disease.

Most people with chronic kidney disease do not progress to needing dialysis. But for those who do, planning often starts when eGFR is around 20 – 25 mL/min.

This early planning matters because long-term dialysis usually requires special preparation, such as creating a vascular access point for hemodialysis.

Kidney Transplant in Older Adults

Kidney transplant can be an option for some older adults with end-stage kidney disease, especially if they are otherwise in reasonably good health.

However, transplant is a major procedure and requires significant ongoing medical care afterward, including medications to prevent rejection.

Whether transplant is a realistic option depends on the person’s overall health, frailty, other medical conditions, and preferences.

Conservative Kidney Management

Another option for advanced kidney disease is conservative kidney management, which is a palliative approach.

This means focusing on comfort, symptom management, and quality of life rather than dialysis or transplant.

This option can be especially worth considering when someone is much older, frail, has advanced dementia, or has multiple serious medical conditions.

Dialysis can be burdensome. It often involves frequent appointments, procedures, dietary restrictions, and medical complications. For some older adults, especially those with significant frailty or limited life expectancy, dialysis may not improve quality of life in a meaningful way.

A conservative approach does not mean “doing nothing.” It means actively managing symptoms and supporting the person in a way that fits their health situation and goals.

Kidney Disease in Geriatrics: Special Considerations

In geriatrics, kidney disease is very common, and it often interacts with other health problems.

Here are a few important points for older adults and families:

• Many older adults have mild-to-moderate CKD and no symptoms.
• Kidney function should be checked if an older person develops new or worsening confusion.
• Acute kidney injury can happen during dehydration, infection, urinary obstruction, or hospitalization.
• Medication safety becomes especially important when kidney function declines.
• Dialysis and transplant can be options for some older adults.
• Conservative kidney management should also be discussed when advanced kidney disease occurs in someone who is frail or has serious other conditions.

The best approach depends not only on the kidney function numbers, but also on the person’s overall health, function, preferences, and goals.

Questions to Ask Your Health Providers About Kidney Function

If you or your older relative has abnormal kidney test results, consider asking:

• Can I have a copy of my lab results?
• What is my eGFR?
• Is the abnormal result mild, moderate, or severe?
• How does this compare to my prior kidney test results?
• Does this look like chronic kidney disease, acute kidney injury, or acute-on-chronic kidney disease?
• Do I have albumin or protein in my urine?
• What do you think is the most likely cause?
• Could any of my medications be affecting my kidneys?
• Do any of my medication doses need to be adjusted?
• Should I avoid NSAIDs such as ibuprofen or naproxen?
• What is the plan for further evaluation?
• What is the plan for managing or protecting my kidney function?
• How often should my kidney function be monitored?
• Should I see a nephrologist?

It’s also a good idea to keep copies of lab results and track kidney function over time. This can help you and your health providers notice important changes sooner.

The Bottom Line

Kidney disease is common in older adults, and it often causes no symptoms in the early or moderate stages.

The key number to know is usually the eGFR, which estimates how well the kidneys are filtering the blood. Chronic kidney disease is often defined as an eGFR below 60 mL/min for at least three months, or evidence of kidney damage such as albumin in the urine.

The most common causes of chronic kidney disease are high blood pressure and diabetes. Other contributors can include certain medications, infections, blocked urine flow, autoimmune disease, smoking, obesity, and age-related decline.

For most older adults with CKD, treatment focuses on monitoring kidney function, controlling blood pressure and blood sugar, avoiding kidney-stressing medications, adjusting medication doses when needed, and slowing progression.

And for those who develop advanced kidney disease, it’s important to understand all the options, including dialysis, transplant, and conservative kidney management.

I hope this article has helped you better understand any kidney disease affecting your life or that of someone you care about. 

Are you on medication to lower blood pressure? Or are you caring for an older person with hypertension, also known as high blood pressure? 

If so, you are probably wondering just what is the right blood pressure (BP) for older adults.

This is a good question, given that guidelines on blood pressure for older adults changed as a result of the landmark Systolic Blood Pressure Intervention Trial (abbreviated as “SPRINT”).

The SPRINT study first made headlines in part because the findings seemed to contradict expert hypertension guidelines released in December 2013, which for the first time had proposed a higher goal BP (a systolic BP of less than 150mm mercury) for most adults aged 60 or older.

In particular, SPRINT randomly assigned participants — all of whom were aged 50 or older, and were at high risk for cardiovascular events — to have their systolic blood pressure (that’s the top number) treated to a goal of either 140, or 120. Because the study found that people randomized to a goal of 120 were experiencing better health outcomes, the study was ended early.

For those of us who specialize in optimizing the health of older adults, this was obviously an important research development that could change our medical recommendations for certain older adults.

But what about for you, or for your older relative? Do the SPRINT results mean you aim for a BP goal of 120?

Maybe yes, but quite possibly no. In this article, I’ll help you better understand the SPRINT study and results, as well as the side-effects and special considerations for older adults at risk for falls. This way, you’ll better understand how SPRINT’s findings might inform the BP goals that you and your doctors choose to pursue.

Here’s what this post will cover: 

• What is currently considered “normal” blood pressure for older adults in their 60s, 70s, 80s
• What the latest blood pressure guidelines recommend
• What to know about the landmark SPRINT blood pressure in older adults trial, including who was included and excluded, and what type of BP medications were used most often
• What the actual likelihood of benefits and harms was within SPRINT, and what you might expect if you are similar to the SPRINT participants
• Why you probably need to make a change in how your blood pressure is measured before considering a SPRINT-style systolic BP goal of 120
• My own approach and how to avoid over-treatment of high blood pressure

I also cover the details of this article in video form on my Youtube channel: 

What is considered normal blood pressure for older adults?

Blood pressure is usually recorded as the systolic blood pressure over the diastolic blood pressure. These are measured in millimeters of mercury (“mm Hg”). The systolic measurement (the “top number”) is usually much more important, when it comes to stroke risk and more practical medical considerations. (For more on the basic terminology of blood pressure, see this article.)

As of 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) are defining normal blood pressure and high blood pressure using the same ranges for all adults, regardless of age or gender.

Here is the definition of normal blood pressure (and hypertension) per the ACC/AHA:

BP Category	Systolic BP		Diastolic BP
Normal	120 mm Hg	and	80 mm Hg
Elevated	120–129 mm Hg	and	80 mm Hg
Hypertension
Stage 1	130–139 mm Hg	or	80–89 mm Hg
Stage 2	≥140 mm Hg	or	≥90 mm Hg

In short, if you are wondering what is “normal” blood pressure by age: whether a person is in their 60s, 70s, 80s, or 90s, normal blood pressure is considered to be a BP less than 120/80.

Furthermore, the definition of normal blood pressure does not vary between men and women.

Do geriatricians define normal blood pressure differently?

The American Geriatrics Society has not attempted to define normal blood pressure in older adults. 

That said, here is the approach that most geriatricians — including myself — take when it comes to blood pressure:

• We first focus on helping an older adult get their systolic blood pressure down to the 140-150mm Hg range.
  • After we reach a BP in the 140s, we consider more intensive treatment if it seems feasible and if the older person is not experiencing worrisome side-effects from blood pressure medication.
• We are very alert to the possibility of blood pressure being too low; some older adults feel weak or dizzy when they stand up, especially if their sitting systolic blood pressure is below 120.

For more on how we approach blood pressure treatment, see this article: 6 Steps to Better High Blood Pressure Treatment for Older Adults.

I also recommend learning more about the landmark SPRINT blood pressure trial, which I explain later in this article.

Is there such a thing as low blood pressure?

Yes, this is called hypotension.

Interestingly, the ACC/AHA do not define a lower limit for normal blood pressure. Instead, hypotension is often defined as blood pressure being “lower than expected.”

Generally, a reading of less than 90/60 mm Hg is considered hypotension.

Older adults are also prone to experience something called orthostatic hypotension, which means experiencing a decline >20 mm Hg in systolic BP or >10 mm Hg in diastolic BP, within a few minutes of standing up.

Because orthostatic hypotension can be associated with falls or with passing out, checking BP sitting and standing is one of the things geriatricians do after a fall. (Learn more things to do after a fall here: 8 Things to Have the Doctor Check After an Aging Person Falls.)

What do the newest (2025) blood pressure treatment guidelines recommend?

In the US, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines are very prominent. They were last updated in 2025.

The previous 2017 ACC/AHA guidelines did make a recommendation for older adults, which was basically to treat SBP of 130 or higher, and reconsider if there was limited life expectancy.

The latest 2025 guidelines, however, have eliminated age as a consideration for BP treatment. 

Instead, the recommendation for BP treatment for all adults regardless of age is:

• If average BP is ≥ 140/90, initiate BP-lowering medications
• If average SBP is between 130 and 140, evaluate for cardiovascular risk factors and initiate medications if the person is at higher risk
  • Criteria for higher risk include a history of past heart attack or stroke, heart failure, diabetes, and/or chronic kidney disease. Or a 10-year risk of cardiovascular event ≥ 7.5%

The guidelines also note that in older adults who are frail or have limited life expectancy, “a clinician-patient assessment of potential benefits and harms of BP lowering should be pursued to align care with patient goals.”

In other words: 

• Older adults should be treated for high blood pressure if their average systolic BP is higher than 130 mm Hg. The goal should be to get them below 130 mm Hg.
• In those older adults who are chronically ill and may only have a few years left to live, the goal of getting BP below 130 should be reconsidered.

Note: European Society of Hypertension recommends higher BP treatment goals for adults over age 80

The European Society of Hypertension (ESH) issued updated treatment guidelines in 2023. 

Those guidelines do recommend different BP targets based on age, as follows:

• Ages 18-64: target BP 130/80
• Ages 65-79: target BP 140/80, and then target 130/80 if tolerated
• Ages 80+: target BP 140-150/80

You can learn more about the European hypertension guidelines here: 2023 ESH Hypertension Guideline Update: Bringing Us Closer Together Across the Pond.

What to know about the SPRINT trial

Who was — and wasn’t — studied in the SPRINT blood pressure trial 

The current blood pressure treatment guidelines for older adults are very related to the SPRINT trial results. So it can useful to understand this landmark study.

In particular: do the study results apply to you or your older relative? This is one of the two most important questions to ask yourself when you hear exciting news about clinical research. (The other question to ask is “What’s the “number needed-to-treat,” which corresponds to your odds of actually benefiting; more on that below.)

Why? Because a well-done medical study tells us what health outcomes happened when we applied a certain intervention to a certain group of people. If you aren’t like the people who were studied, then there’s a higher chance you won’t experience the benefits that study participants did.

So who was in SPRINT? Here are the criteria the researchers used to define the study group, and enroll participants.

What the SPRINT participants were like:

• Aged 50 or older, with systolic blood pressure of 130-180mm mercury, and 
• At increased risk for cardiovascular disease, which was defined by meeting one of the following conditions:
  • Aged 75 or older. Yep, that in of itself puts people at risk.
  • A 10-year risk of cardiovascular disease of 15% or greater on the basis of the Framingham risk score. You can check your own Framingham risk score here; you’ll need to know your total cholesterol, HDL cholesterol, and systolic blood pressure.
  • Chronic kidney disease, defined by an estimated glomerular filtration rate (eGFR) of 20-60.
  • Clinical or subclinical cardiovascular disease other than stroke. This means things like a history of heart attack, bypass surgery, peripheral artery disease, carotid artery stenting or surgery, or any testing considered “positive” for cardiovascular disease. For a full list of criteria, see the published study’s supplemental materials here.

It’s equally important to consider who was excluded from SPRINT. You may have already heard that SPRINT didn’t cover people with diabetes or stroke, but the exclusion list is much longer than that. (See the study appendix for the full detailed list.)

What the SPRINT participants were not like: Older persons with any of the following diagnoses, conditions, or circumstances were not eligible for the study:

• Diabetes
• Past stroke
• Clinical diagnosis of dementia, and/or being on dementia medication
• People residing in a nursing home. (Assisted living was ok.)
• Substance abuse (active or within the past 12 months)
• Symptomatic heart failure within the past 6 months or left ventricular ejection fraction (by any method) 35%
• Polycystic kidney disease or eGFR 20
• “Significant history of poor compliance with medications or attendance at clinic visits.”

As you can see, quite a lot of common diagnoses and circumstances were grounds for exclusion from the SPRINT study.

Ultimately, 9361 people were enrolled between November 2010 and March 2013. The average age was 68, and 28% of participants were aged 75 or older.

Surprisingly to me, the average systolic blood pressure at baseline was 140, which struck me as better BP control than average older adults. And only 34% of participants had a systolic blood pressure higher than 145 at the start of the study. (For comparison, the CDC reports that only about 1 in 4 adults with hypertension have their blood pressure under control.)

On average, at the start of the study, participants were taking two blood pressure medications.

What did the SPRINT intervention involve?

SPRINT participants were randomly assigned to be treated to a systolic BP goal of either 140, or 120.

Participants were seen once a month for the first three months, and then every 3 months after that.

To treat blood pressure, SPRINT provided all the major classes of BP medication for free, and also allowed clinicians to use other BP medications if they saw fit. Here are the main classes of medication used; I’ve organized them roughly by how commonly they were used (per table S2 of the appendix).

Blood Pressure Medications Used in SPRINT:

• Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), e.g. lisinopril, losartan
• Diuretics, e.g. chlorthalidone, hydrochlorothiazide, furosemide, spironolactone
• Calcium-channel blockers, e.g. diltiazem, amlodipine
• Beta-blockers (encouraged for those with coronary artery disease), e.g. metoprolol, atenolol
• Alpha-one blockers, e.g. doxazosin
• Direct vasodilators, e.g. hydralazine, minoxidil
• Alpha-two agonists, e.g. clonidine

Those last three classes of BP medication were used in 10% of people or less, which makes sense as none of them are recommended as first-line medication choices for hypertension, heart conditions, or kidney disease.

What about non-drug methods to manage high blood pressure? 

In the scholarly publication, the SPRINT investigators say that “Lifestyle modification was encouraged as part of the management strategy,” but they don’t provide more specifics on what modifications were encouraged or how. So it’s hard to know how any non-drug methods — diet, exercise, salt reduction, stress reduction — might have factored into this study.

Benefits and Harms Observed in SPRINT

SPRINT randomly divided participants into an intensive-treatment group, which aimed for systolic BP less than 120, and a standard-treatment group, which aimed for systolic BP less than 140.

After one year, the average systolic BP among the intensive-treatment group was 121, compared to 136 among the standard-treatment group. The intensive group required an average of 2.8 medications to reach their lower BP goal; the standard group required an average of 1.8 medications.

The follow-up period averaged about three years.

Benefits of intensive BP treatment:

During follow-up, 1.65% per year of people in the intensive-treatment group and 2.19% per year of people in the standard-treatment experienced a significant cardiovascular “outcome event”: a heart attack, a stroke, acute decompensated heart failure, or death from cardiovascular causes.

The study authors calculated that “The numbers needed to treat to prevent a primary outcome event, death from any cause, and death from cardiovascular causes during the median 3.26 years of the trial were 61, 90, and 172, respectively.”

In other words, if you are like the study participants, and if you decide to switch from a systolic BP goal of 140 to a goal of 120, over a few years you’ll have:

• A 1 in 61 (1.6%) chance of avoiding a cardiovascular event
• A 1 in 90 chance (1.1%) chance of avoiding death from any cause
• A 1 in 172 chance (0.6%) chance of avoiding death from cardiovascular causes

(For more on the wonderfully useful statistic the Number Needed to Treat, see this informative NYT article and also the website www.thennt.com.)

Harms of Intensive BP Treatment

The SPRINT investigators were careful to track side-effects and complications. They found that serious adverse events occurred in 38.3% of the intensive-treatment group and in 37.1% of  the standard-treatment group.

Adverse events included problems like hypotension (low blood pressure), syncope (passing out), electrolyte problems, declines in kidney function, and injurious falls. Most problems affected 1-7% of participants, with the exception of orthostatic hypotension — which means BP dropping with standing — which affected 16-18% of participants. (Standing BP was checked at baseline, 1, 6, and 12 months and yearly thereafter.)

Although many side-effects were a little more common in the intensively-treated group, injurious falls were equally common in both treatment groups, and affected 7.1% of participants.

This finding is actually consistent with what was reported in a 2014 study of serious falls (e.g. bone-breaking falls) in older people with high blood pressure. In that study, the researchers classified people as being on no BP medication, moderate-intensity BP treatment, or high-intensity BP treatment. Moderate- and high-intensity treatment was linked to a nearly equivalent risk of falling over three years (about 8.5%), whereas 7.1% of older adults on no BP medication had a bad fall.

How Blood Pressure Was Measured in SPRINT

Blood pressure was measured in a very careful way that is quite different from the way patients usually have BP measured by their doctors. Here’s what they did in SPRINT:

• Had people sit down and rest for five minutes before checking BP
• Checked BP three times consecutively, using an automated BP monitor (Omron 907)
• Used the average of those three BP measurements to assess the person’s BP and determine whether medications should be adjusted up or down.

Obviously, this is not the experience that most people have in the doctor’s office, and likely led to lower BP measurements than those taken under usual circumstances.

If you are similar to a SPRINT participant and are thinking of aiming for a lower BP goal, be sure to request that your BP is checked in a similar way. In truth, it’s a much sounder basis for changing a patient’s medications, but it’s not usual care at this time.

And remember: even if you’re like the SPRINT participants — and you might not be — aiming for the lower BP goal likely gives you a 0.5%-1.5% chance of avoiding a bad health outcome. (Whereas you’ll have a very high percent chance of having to take more medication every day.)

If you want to learn more about SPRINT: 

SPRINT really was a fascinating research trial, and has led to several interesting sub-analyses. You can learn more about SPRINT results specifically in people over age 75 here: Important Blood Pressure Research: What to Know About SPRINT-Senior.

Do I usually try to get my older patients to “normal” blood pressure?

Given the results of SPRINT and the guidelines, you may be wondering how I personally approach treating high blood pressure in my patients.

In terms of my personal practice: I see a lot of older people who are worried about falls, and a well-done study published in 2014 found that blood pressure treatment was associated with serious — as in, bone breaking — falls. (Read my coverage of this study here.)

I also find that many of my patients are struggling to manage multiple medications, and are at risk for interactions from their medications. For instance, all the medications used in SPRINT have side-effects to watch out for, and many can interact with other medications or chronic diseases.

There is indeed good scientific evidence that for those older adults who have a systolic BP in the 160s or higher, getting them down to a systolic in the 140s does reduce the chance of strokes and other serious cardiovascular diseases. (See here and here.) So it’s certainly important to identify serious hypertension in older adults, and treat it if possible.

But given the relatively small absolute benefit of aiming for a systolic blood pressure of 120, I have found that for most of my patients, aiming for a systolic BP in the 140s is reasonable.

Now, you are likely still wondering what’s the right blood pressure goal for you or your older relative. I can’t tell you for sure for your particular situation. But here’s more information on why it’s worth being careful about over-treating high blood pressure.

Why Older Adults Should Watch Out for Over-Treatment of High Blood Pressure

In my experience, many older adults are taking more BP medication than they need, meaning they’ve reached a point at which the risks and burdens outweigh the benefits (compared with less aggressive treatment of high blood pressure).

This can cause falls or dizziness due to orthostatic hypotension, and one of the most common medication changes I implement as a geriatrician is the cutting back of blood pressure medications. 

How can you know if you might be dealing with over-treatment of high blood pressure? Here are the steps I recommend:

1.Check the older person’s blood pressure, and know what his/her systolic BP is. The best way to do this is to use a high-quality BP machine, and to have the BP checked at the same time of day, for 3-7 days in a row. If possible, check twice a day instead of once a day. (For more on checking BP at home, see this post.) 

• Since blood pressure is constantly changing a bit within the body, a series of measurements gives a more accurate idea of where a person’s BP usually is.
• Home-based BP checks have been shown to correlate better with a person’s true BP than occasional office-based BP checks.
• If there have been any falls, or if systolic BP is less than 120, consider checking BP both sitting and standing. If BP is dropping a lot when the person stands (which is a sign of orthostatic hypotension), you’ll want to ask the doctor to address this.

2. Plan to talk to the older person’s doctor about reviewing the blood pressure treatment plan. This is especially important if:

• Sitting systolic BP is less than 130mm Hg and you’re noticing a drop of 20 mm Hg or more when the older person stands.
• Sitting systolic BP is less than 120 mm Hg and you’ve been worried about falls.
• Sitting systolic BP is less than 110 mm Hg.
• Sitting systolic BP is often over 150 mm Hg (in which case, we might be dealing with under-treatment of hypertension).

For more on how to figure out blood pressure treatment for people in their 60s, 70s, 80s, or 90s, see here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.

[This article was reviewed and updated in June 2026.]

Have you noticed worrisome changes in your aging parent?

Maybe they’ve been mostly okay but now you’re seeing problems with memory, such as forgetfulness or asking the same questions repeatedly. Or maybe you’ve noticed trouble with driving, keeping up the house, managing stairs, or paying bills. 

Some aging parents simply begin to seem more withdrawn. Others start leveling accusations at others, claiming someone took or moved something, or acting paranoid.

For many adult children, these changes lead to mounting questions. What’s wrong? What’s happening? Is it safe for Mom to keep driving? Should Dad live alone much longer?

I think of this as the “uh-oh” stage. It’s a transition no one looks forward to, and most haven’t prepared for: the time when you might have to start helping your aging parent.

And for many, it comes with an added challenge:  Most aging parents don’t welcome much help from their adult children. They may see it as interference, or an invasion of privacy.

Some parents might even refuse to accept that they’re having difficulties, despite issues that feel glaringly obvious—and concerning—to you.

By the time you’re noticing changes and have safety concerns, it’s quite possible that you’re right: that your parent does need help of some kind. So how should you best get involved, especially if your attempts to do so have gone poorly in the past?

Well, it’s certainly not easy. These situations are complicated from a medical and eldercare perspective, plus they tend to bring up difficult emotions for older parents and adult children alike.

But I do believe that it’s crucial for families to get involved. It’s not likely to be easy. But it can be easier, if you’re able to learn the better ways to do so—and also what to stop doing.

The very best way to learn this is to work closely with professionals trained to assist aging adults, such as geriatricians and geriatric care managers (who are also known as aging life care experts). 

That said, geriatricians are in short supply and can be hard to find, and geriatric care managers must be paid out of pocket (although it’s often a worthwhile investment). And although local Area on Aging Agencies do exist and can be great resources, they’re also often short-staffed and underfunded. 

That’s why I’ve created this article for you, explaining a step-by-step process that anyone in this situation can follow. It’s based on what I help families do, when I advise them on how to step in and assist an aging parent.

Here’s an overview of the steps:

1. Collect the facts on the situation, by checking for specific signs an aging parent needs help or is unsafe, and by respectfully gathering information from others.
2. Get your parent’s perspective, so you can understand how they see the situation and what’s important to them, before you make any more attempts to get them to make changes. (Don’t even think about getting them to understand, agree, or accept what’s going on during these initial conversations.)
3. Find out what an ideal medical and eldercare intervention looks like, to guide plans if there really are signs of memory problems, safety issues, or declines in independence.
4. Learn some legal fundamentals about signs that mental “incompetence” or “incapacity” might be an issue, and  about legal documents, such as powers of attorney, that can better enable you to assist your aging parent.
5. Create an actionable plan that addresses what’s most important, based on what you’ve learned about your parent’s situation and priorities so far. Every family is different, but usually what’s most important might involve:
   1. Working on getting a medical evaluation, and hopefully a diagnosis
   2. Addressing the most important safety and care issues
   3. Connecting with your parent and persuading them to accept at least some changes
6. Implement your plan. Be prepared to make several attempts, because that’s usually what it takes.

(Want a much more detailed version with checklists, sample dialogue to say, workarounds for common obstacles, and “what this looks like” examples? That’s all in my book When Your Aging Parent Needs Help, and you can learn more about it here.)

Let me now explain these six steps in a little more detail:

1. Get the facts: Checking for signs your aging parent needs help

You might think you know what’s going on but surprisingly, our starting assumptions can be wrong or incomplete. That’s why it’s important, before  you do anything else, to try to gather information that will help you confirm that your worries are justified. I recommend checking  on these particular things:

• Signs of problems with memory and thinking
• Signs of problems with life tasks and safety
• What other family members and key people in your parent’s life are noticing
• Any  “bright red flags” that indicate you probably should step in sooner, rather than later

To help people check for worrisome signs, I created a free downloadable guide a few years ago, with easy-to-use checklists. You can get it here: Quick Start Guide to Checking for Health & Safety Problems.

Making a systematic effort to gather this information will help your family have a clearer picture of the problems and concerns. Doctors and eldercare experts will also need details about what’s going on, whether to help them make a diagnosis or just figure out what kind of support and safety measures will be needed.

2. Get your parent’s perspective: How to learn what matters to them and how they’re seeing things

Even if you’ve already tried talking to your parent(s)—and if you’re like many of the families who write to me, you have—chances are good that you haven’t yet used the most effective approaches. 

Families often talk to a declining older person with the intention of getting them to understand, or accept, that problems have arisen and that certain steps should be taken to keep them safe and well.

This is well-intentioned and understandable. Unfortunately, it tends to be counter-productive and often leads to frustration and conflict.

So you’ll want to take a different approach to these talks. Which is to “talk” with the intention of listening, and helping your parent feel heard.

This is the way a geriatrician approaches a patient, especially one who is reluctant or resistant. You want to listen intently, to learn more about what they’re thinking, feeling, and preferring.

At the same time, you’ll want to avoid arguing, correcting, or attempting any convincing. (Now is not the time.)

When you learn more about how your parent sees a certain situation, and what matters the most to him or her, you’ll end up in a stronger position to invite them to try a change you think will help them.

Taking this important step can help soften resistance and improve the odds of practical success. Many families are relieved to find it also  builds “relationship capital”—goodwill you’ll need for the challenging future.

For more on how to talk about a tricky concern, try this video (it’s about memory loss, but you can use the same technique to ask about something else you’re concerned about):

3. Get informed: What an ideal medical and eldercare assessment and intervention looks like

Let’s face it, what’s “ideal” doesn’t always happen. Still, it’s super useful to know what experts advise should happen, in a perfect world where you could control everything, because this gives you a guide for where to aim your best efforts. That can save you time and trouble later. 

Key is getting a medical evaluation. This is because most worrisome “life” problems families notice in an aging parent are actually being caused or worsened by an underlying medical issue. You want to get answers to questions like: What might be causing the symptoms we’re concerned about? Could medications be an issue? (They often are.) What’s the plan for follow-up and what happens next? 

If you’ve been worried about memory or other thinking skills, the doctor (and starting with your parent’s primary-care provider is fine) should look for underlying causes of cognitive impairment. For more on what should be checked, see Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check. If your main concern is paranoia or false accusations, also see 6 Causes of Paranoia in Aging & What to Do.

The ideal approach also involves taking steps to address immediate safety concerns and assist your parent with any daily life tasks they’re currently struggling with.

Working with specially trained social workers or geriatric care managers can be very helpful to assess housing and care needs, and to come up with a plan to meet them. These professionals also usually have ideas on how to manage common safety concerns, such as driving difficulties , or trouble managing finances.  Or you can begin to look for resources in the area to help you. I suggest some excellent starting places in this article. The Quick Start Guide also includes ideas on how to get help with any problems you notice.

Last but not least, setting up certain lifestyle changes can help an aging parent maintain the best possible physical health, and can also slow cognitive decline, if any is present. For my top suggestions on maintaining a healthier brain, see here, and for my suggestions on maintaining physical health, see here.

4. Learn about the potential legal angles: Signs of mental “incompetence” or “incapacity” and legal documents to check for

If you’ve noticed any problems with memory, judgment, or other thinking skills, then it’s a good idea to learn more about mental capacity and when an older person might be considered incapacitated or “incompetent.”

This matters for several reasons. One is that if your parent has ever completed a power of attorney for healthcare, or for legal affairs, it may only give you (or someone else) the ability to act if they are “incapacitated.” (This is sometimes called a “springing” power of attorney.)

It also matters because if there are signs that an older person has lost the capacity to mentally understand the risks of a given situation, then it becomes more ethically – and sometimes legally – permissible for you to intervene.

Now, just because your aging parent rebuffs your concerns, ignores safety issues, or refuses to accept help, that doesn’t mean he or she has lost mental capacity.  Still, it can be a good idea to learn more about capacity so you’re clearer about whether to look into it more now, and in case the situation changes.

Your understanding of your parent’s mental capacities can and should affect how you approach them when the time does come to take next steps, or try to convince them to make a change. 

You can learn more about capacity here: Incompetence & Losing Capacity: Answers to 7 FAQs. For more on powers of attorney, see here.

5. Put it all together: Create a next-steps action plan customized for your family’s situation and parent’s preferences

Now that you’ve laid the important foundation of observing, listening, and learning, it’s time to put it all together and take action.

Obviously, there’s no single “right” way to go about helping an aging parent; what you do will depend on what’s going on with your parent, what matters to them, what’s feasible, and more. 

Here’s an A-B-C formula can help you create a plan that works for you:

1. ASSESS: First, you want to review your assessment of the situation right now: your parent’s thinking skills, observed safety issues, life tasks they’re struggling with, and other key issues, as well as your parent’s/family’s priorities. You’ll also want to review how much of the ideal next steps have taken place so far.

2. BRAINSTORM: You’ll then weigh your options for taking next steps. You’ll need to consider things like:

• What seems most urgent/important to address?
• What seems most feasible?

3. CHOOSE AND PLAN: Based on what you’ve brainstormed, pick one to three issues you’re going to focus on. (If you have siblings or other involved family members, it’s best to do this together and coordinate.)  For each issue, plan some specific next action steps. These might include:

• Something to research (a health problem, a legal point, a service, an agency, experts, and so on).
• Something to do (make a call or appointment, tour a facility, review medication, hire someone, and so on).
• A conversation to have (with your parent or sometimes someone else, like a consultant, the doctor, a neutral third party, a sibling, your other parent, and so on).

6. Implement your action plan: Be prepared to persist 

NOW you’re ready to effectively step in and try to “do something” to help your aging parent. Give it your best go, taking the next steps you’ve planned out.

Be sure to use your best communication skills and consider capacity issues, if appropriate. (They often are.) Failing to focus on good communication and the importance of capacity trip up many families.

Based on how things go, you’ll reassess, adjust your approach, and likely try again. I like to tell people they should plan on “experimenting,” because families almost never get the progress they’re hoping for right away.

In fact, it’s normal for this part to involve a lot of back-and-forth as you try to move past certain roadblocks or figure out the best tack to take with your parent (or with someone else who’s involved, such as another family member or your parent’s doctors).

There’s an art to learning to persist and try a few different approaches as you try to help your aging parent. To get past the most common roadblocks, such as your parent refusing to go to the doctor, I recommend crowdsourcing ideas and advice from others in a support group; there are some good free ones online. 

I also have a whole chapter on getting past common roadblocks in my book, “When Your Aging Parent Needs Help: A geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more.”

No matter what happens next, consider it progress

If you follow the steps outlined above and persist, the odds are very good that you’ll get your parent more of what they need for their care and safety—and you’ll likely get them to come to better acceptance of the changes.

Now, it’s definitely possible to do all the “right things” but still end up feeling stuck. That’s not unusual. There are, in fact, additional options to consider, if you’ve made multiple well-thought-out attempts to help yet feel your efforts are going nowhere.

For instance, it may be appropriate to consider “watchful waiting,” or even looking into last-resort measures such as petitioning for guardianship. (These are beyond the scope of this article; my new book includes a separate chapter on these scenarios.) 

Even if things stabilize, you’ll probably have a sense that something has changed since your initial “uh-oh” moments. And it has. Your family has shifted to a new stage of life.

The “new normal” might wind up feeling familiar (if seldom exactly the same as before), allowing you to step back awhile. Or you may be in active “help mode” for a long time. That’s pretty common. 

Whatever this ongoing journey through this stage of life is like for you and your parent, simply by approaching your aging parent using this thoughtful and caring process, you will be making a needed difference. 

That’s because what your parent needs most of all, during this time of change for them, is your presence and your connecting with them. You won’t be able to control everything and you probably won’t be able to get all the safer outcomes you want for them.

But that’s ok. You’re showing up to help, you’re learning to do it in better ways, and you’ll be doing the best you can to accompany them on their aging journey. And that will make a huge difference for your aging parent.

I hope this article and my step-by-step process will be helpful to you. If you have questions or comments, please post them below.

You might also find my free online training for families helpful (see below), in which I teach families how to help reluctant older loved ones.

Sleep. Everybody needs it. Many of us don’t get enough of it.

These are common truths that almost everyone knows. But a few years ago, I had the opportunity to learn quite a bit more about sleep, and how it affects health.

I came away convinced that sleep is a core pillar of health. It deserves more attention from us as doctors, and as individuals concerned about our own health or that of an aging relative.

I also know that sleep problems are very common among family caregivers, and among aging adults. So I was glad to learn more about sleep health, as this has the potential to really help people get through caregiving and aging challenges.

In this article, I’ll share some of the interesting facts I learned about sleep, including how it affects the health of the body and mind, and how it changes with aging.

You may also want to read my related articles:

• 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
• How to Manage Sleep Problems in Dementia

4 Things To Know About Sleep & Health

1. You may need more sleep than you’re currently getting. 

This is a no-brainer if you’re struggling with insomnia, or walking around haggard because you’re caring for an older person with sleep problems.

But even people who don’t feel chronically sleep-deprived are often getting less sleep than they need. This can have important health effects both short-term and long-term.

So how much sleep does a person need? Here’s how to answer this question. First, you can reference this table from the National Sleep Foundation. It shows the range of nightly sleep time that people need, depending on age group. For adults, most people need 7-9 hours every night, with older adults needing a little less.

That range is just a starting point, however. To determine how much sleep you or another person needs, you really need to figure out how much sleep is required for the person to feel refreshed upon awakening, and alert throughout most of the day.

According to experts, a lull in alertness after lunch is common, but it’s not normal to feel very sleepy during boring activities such as meetings or highway driving. If you are getting a healthy amount of sleep, you should feel fairly alert throughout most of the day and evening, without having to resort to frequent cups of coffee or use of other stimulants.

Note that the sleep needs to be of “good quality.” Factors such as sleep apnea (which causes frequent micro-awakenings), restless leg syndrome, or even certain medications can diminish sleep quality, which means a person can sleep for the “right” number of hours but still feel tired during the day.

Alcohol is another common cause of poor sleep quality. Although it does often make people feel sleepy, it interferes with getting enough restorative sleep throughout the whole night, and sometimes causes people to wake up during the night.

2. Being sleep-deprived is common…and you may not realize it’s affecting you.

Sleep deprivation comes in two flavors. Acute sleep deprivation means getting less sleep than usual over a night or two. This leads to people feeling noticeably worse than usual during the day. They also perform worse on cognitive tasks.

Chronic sleep deprivation, on the other hand, means not getting quite enough sleep for weeks, months, or even years. A large survey done in 2010 found that 30% of adults aged 45+ reported sleeping six hours or less on most nights.

Studies suggest that most people develop a certain tolerance to chronic sleep deprivation, so they don’t feel nearly as bad as after an episode of acute sleep deprivation. However, a landmark study published in 2003, in which young-ish adults (aged 21-38) were randomized to get 4, 6, or 8 hours of sleep for 14 days in a row, found that chronic sleep deprivation did affect performance much more than participants seemed to realize. (The study overall found that cognitive abilities got progressively worse for those getting 4 or 6 hours per night.)

In other words, when people experience acute sleep deprivation, their sense of feeling crummy and tired is aligned with the actual impact of not sleeping enough. But when people are chronically sleep deprived, they tend to underestimate how much it’s affecting them.

3. Acute sleep deprivation affects people in many ways.

Acute sleep deprivation is when you pull an all-nighter, or otherwise sleep a lot less than you usually do. Here’s what research reveals about the effect of a low-sleep night:

• Decreased cognitive performance. This includes having a harder time paying attention, multi-tasking, completing logical thinking tasks, or problem-solving.
•  Worsening of mood. People tend to be more irritable, more anxious, and sometimes more depressed. The symptoms can mimic depression or anxiety.
• Daytime sleepiness. Not only do people feel sleepy, but this can also cause people to actually fall asleep for a few seconds if they are driving, sitting in a meeting, or otherwise doing something monotonous or not physically active. Obviously, this can be quite dangerous and is a major contributor to car accidents.
• Fatigue. Fatigue means feeling a certain lack of physical or mental energy. This differs from sleepiness, which is the actual feeling of wanting to fall asleep, or having difficulty staying awake. (Many insomniacs feel fatigued but not sleepy, to their great dismay.)

Interestingly, how badly you are affected the day after not sleeping enough seems to depend not only on how little you slept, but also on how chronically sleep-deprived or well-slept you were before your bad night.

As you might guess, if you are chronically sleep-deprived then you’ll be even worse off after a particularly low-sleep night.

4. Chronic sleep deprivation is associated with long-term health effects.

Chronic sleep deprivation reduces your alertness and mental performance. It’s also been linked to a number of health and life problems, including:

• Anxiety and/or depression. A study found that frequent insufficient sleep was linked to a much higher likelihood of having anxiety, depression, or both.
• Developing cardiovascular disease. A study that followed 495 healthy people and measured their sleep with a wrist device found that those who slept more were much less likely to develop significant calcification of their coronary arteries. Another study of 20,000 adults found that those who slept less than 7 hours per night — and often woke feeling unrested — had a higher risk of cardiovascular disease.
• Increased inflammatory markers in the body. Studies have found that reduced sleep leads to elevated blood markers related to inflammation. Experts believe this could explain the relationship between chronic sleep deprivation and cardiovascular disease.
• Weaker function of the immune system. Sleep deprivation has been linked to decreased production of antibodies. One especially interesting study found that people who slept less were almost three times more likely to develop a cold. (Study participants were inoculated with rhinovirus after their sleep was tracked; overall 43% developed a symptomatic cold, which is interesting in terms of understanding how likely you are to get sick after being exposed to this type of cold virus.)
• Increased risk of obesity. A 2008 meta-analysis (a study of research studies) found that being a short-sleeper is associated with obesity. A study of acute sleep deprivation in young men found that not sleeping enough changed hormones associated with appetite.

3 Ways Sleep Changes With Aging

It’s not uncommon for older adults to develop a physical health problem that affects sleep; common  ones include sleep apnea, gastroesophageal reflux disease, heart failure, untreated pain, and frequent urination. (I will cover a comprehensive list of such problems in a future post.)

But even in the absence of a health problem, aging changes sleep. Here’s what experts have found out so far:

• Total sleep time decreases as we age. One study concluded that it decreases by 30 minutes per decade, starting in mid-life.
• Sleep becomes lighter and more fragmented. The amount of time spent in REM sleep declines, and “sleep architecture” otherwise changes a bit as people age.
• The body’s inner circadian rhythm changes.  The circadian rhythm is basically a daily pattern that affects most processes within the body. It’s regulated by certain parts of the brain, by certain hormones (including melatonin), and by exposure to daylight. As people age, many seem to advance the “phase” of their circadian rhythm, meaning they get sleepy earlier in the day and wake up earlier. Experts also believe the rhythm signal tends to weaken with age, so there’s less of a clear signal organizing the body’s processes to be in synch with each other and with the day.

In short, it’s normal for one to sleep a little less, and less deeply, as one ages.

It’s also normal to shift to an earlier schedule, and become more of lark than a night-owl.

That said, experts believe that most sleep problems reported by older adults are related to a physical health problem, a mental health problem (which can include chronic insomnia, as well as other problems related to mood or the brain), or a medication effect.

So if an older adult complains of poor sleep, never assume it’s just “getting old.” Instead, it’s important to investigate further, as it’s often possible to improve an older person’s sleep once we identify the underlying problems.

What To Do If You’re Worried About Sleep

As I explain above, it’s pretty common to not get enough sleep, and it can really affect a person’s health and quality of life.

If you’re worried about sleep, be sure to read my related article: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.

In the meantime, if you often feel tired, sleepy, or irritable, I’d encourage you to assess your own sleep habits, and check to see if you might be chronically sleep-deprived.

Today, smartwatches or a wearable tracker can make it easy for you to log your sleep for a few weeks. Try combining those with a journal of how rested you feel in the mornings, and how often you feel sleepy during the day.

That should help you determine whether you’re chronically sleep deprived.

Questions or comments? I’d love to know how you feel about sleep in later life.

Have you ever had questions about what might be going on with an older loved one’s health? But then you find that your older relative is unable — or unwilling — to let you in on the health details?

Or maybe you’ve wanted to talk to your parent’s doctor, but worried that doing so might be a HIPAA violation?

Such issues come up often for the family caregivers of aging adults. Common situations include:

• An older parent who starts to act in ways that are strange or worrisome, such as becoming paranoid or delusional.
• An older adult who seems to be physically or mentally declining, but seems reluctant to discuss the situation
• A hospitalization or emergency room visit
• A hospitalized older person becoming confused (this would be delirium) and becoming no longer able to explain to family what the doctors have said

In these situations, family caregivers often find themselves grappling with issues related to the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

Why all the grappling?

Well, although most people — and all clinicians — have heard of HIPAA, its rules and requirements are often misunderstood. So for instance, families may assume that it’s a HIPAA violation to report a relative’s worrisome behavior to the doctor, because their relative hasn’t given them permission to do so.

Even worse:  doctors and other clinicians sometimes refuse to disclose any information to families, and will incorrectly claim that it’s a HIPAA violation to do so. This can create extra confusion and stress for families, or can even sometimes put an older person at risk for harm.

If you’ve been concerned about an aging parent’s health, or are otherwise helping someone with their health concerns, then it can be very helpful to understand HIPAA better. HIPAA regulations will also govern your access to medical records and other important health information.

In fact, the American Bar Association includes “Know your rights of access to health information” among its Ten Legal Tips for Caregivers.

The detailed ins and outs of HIPAA can indeed be hard to fully understand. But, it’s not too hard to learn some practical basics, especially since the US Department of Health and Human Services (HHS) provides a Summary of the Privacy Rule here, and maintains a truly useful set of online FAQs about HIPAA here.

In this article, I’ll explain five useful key basics to help you understand HIPAA better, especially when it comes to getting information and medical records as a family caregiver.

I’ll also address five questions I’ve often heard family caregivers ask about HIPAA.

At the end, I’ll share some of my favorite online HIPAA resources, as well as some final tips to keep in mind.

5 Key Basics About HIPAA

1. What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law passed in 1996. Among other things, HIPAA required the Department of Health and Human Services (HHS) to create a federal “Privacy Rule” for health providers and health plans, governing how these entities must protect the privacy of an individual’s medical information.

Usually, when people refer to HIPAA, they are actually referring to the HIPAA Privacy Rule created by HHS.

The HIPAA Privacy Rule basically says that “covered entities” must take certain steps to keep a person’s health information confidential and secure.

“Covered entities” means health providers, health insurers, and many other professionals whose daily work involves the handling of individuals’ medical information.

Private citizens and family caregivers are not “covered” by the Privacy Rule. This means that you do not have to maintain your — or your older parent’s — health information confidential in the same way that health providers do.

Exactly how “covered entities” should comply with the Privacy Rule can get pretty complicated to explain. What is most important for you to know is that this often — but not always — means taking steps to make sure that patients are in agreement, before their health information is shared with other people.

Overall, HIPAA is intended to balance a person’s right to privacy with the need for health providers to share medical records and otherwise communicate with others, in order to properly care for a patient and act in the patient’s best interest.

To read about the rule in more technical detail, see here: Summary of the HIPAA Privacy Rule.

To read a good plain-English summary of your rights (as an individual) under HIPAA, see here: Your Rights Under HIPAA.

2. What information is protected by HIPAA?

HIPAA’s Privacy Rule protects all “individually identifiable health information” held or transmitted by a covered entity, no matter what form it is in. So HIPAA applies whether a person’s health information is held or disclosed electronically, orally, or in written form.

A person’s health information is often referred to as “protected health information” (PHI). This covers information that relates to:

• a person’s past, present or future physical or mental health or conditions
• any health care provided to a person (e.g. clinical notes or lab results related to a person’s medical care)
• past, present, or future payments related to a person’s health care (e.g. billing records)

In other words, this is information created by, or stored by, healthcare providers and insurers, such as medical records.

HIPAA also covers demographic data and any information that can be used to identify a person, such as names and addresses.

If you are a family caregiver, remember that you are not a “covered entity.” Hence you aren’t responsible for protecting health information in the same way that your relative’s doctor is.

3. What to know about HIPAA’s rules on the disclosing of protected health information without committing a HIPAA violation

You’ll be able to sort out what is and isn’t a HIPAA violation more easily if you understand a few fundamentals about HIPAA’s rules on these issues.

According to the HHS Summary of the HIPAA Privacy Rule: “A covered entity may not use or disclose protected health information, except either:

(1) as the Privacy Rule permits or requires; or
(2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing.”

In other words, doctors are allowed to disclose health information if a person authorizes it in writing, or if the Privacy rule otherwise permits or requires such disclosure.

Now, let’s address the difference between being required and being permitted to disclose, because that is really at the heart of a lot of HIPAA confusion.

The difference is that when doctors are required to disclose, then they have to do it, whether or not they want to.

Whereas when they are permitted to disclose, they are allowed to do it, but they don’t have to. (Which means, they might refuse to do it, and they are legally allowed to do so, unless other federal, state, or local laws apply.)

You now probably will want to know: under what circumstances are health providers required or permitted to disclose health information?

Required disclosures of health information. Health providers must disclose protected health information in these two situations:

• When individuals — or their personal representatives — request access to their protected health information. Individuals can also request an accounting of disclosures, which means the covered entity has to tell a person with whom the information was shared.
• When the Department of Health and Human Services requests information, as part of a compliance audit or enforcement investigation.

In short: if you request it, your doctors must give you copies of your medical records. This is known as the “Right of Access.” You can learn more about your rights to view or obtain copies of your health information here: Individuals’ Right under HIPAA to Access their Health Information.

And if you are the durable power of attorney for healthcare for your relative, and if you are currently authorized to act, you have the right to request and obtain your relative’s health information.

Permitted disclosures of health information. Under certain circumstances, health providers are allowed — but not required — to disclose information, without obtaining the patient’s written permission.

Now here’s where things start getting trickier, because the list of permitted circumstances is much longer and more complicated than the list of required disclosures.

If you want to learn about all the permitted disclosures and uses, you can do so by reading the HHS Summary of the Privacy Rule.

But I think it’s more useful to learn from the FAQs that HHS has published online, especially the ones created to guide doctors and other healthcare professionals. I will share some of the more useful ones in the next section, when I address FAQs based on the questions I’ve had people ask me.

For now, the main thing you should know is this: in many cases, health providers are allowed, but not required, to disclose health information to others, even if a patient doesn’t give written or verbal permission for this.

As you will see below, when we go through some FAQs, doctors are allowed to use their clinical judgment and disclose information when a patient lacks capacity to give consent, if the clinician decides that the disclosure is in the best interest of the patient.

4. What to know about HIPAA’s “minimum necessary” requirement

The HIPAA Privacy Rule describes a principle of “minimum necessary” use and disclosure:

“A covered entity must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request.”

Basically, this means that when health providers disclose health information to someone other than the patient, they can’t just disclose anything and everything about their patient’s health. Instead, they should only share on a “need to know” basis, and focus on what’s relevant and necessary.

Note that the minimum necessary requirement does not apply to all disclosures. The Privacy Rule summary lists six situations as exempt, including “disclosure to or a request by a health care provider for treatment.”

In short, if your doctor refers you to another doctor, she can send your whole medical chart along. But, if a doctor is speaking to your family while you are sick in the hospital, the doctor is only allowed to disclose what is necessary and relevant to your current hospitalization and care needs.

5. What is a “HIPAA release”?

Many health providers and other covered entities will require a person to sign a written authorization, before they disclose protected health information. This is sometimes called a HIPAA release, a HIPAA waiver, or a release of information authorization.

Interestingly, the HIPAA Privacy rule itself does not require health providers to do this. Instead, per the Summary:

“Obtaining ‘consent’ (written permission from individuals to use and disclose their protected health information for treatment, payment, and health care operations) is optional under the Privacy Rule for all covered entities. The content of a consent form, and the process for obtaining consent, are at the discretion of the covered entity electing to seek consent.”

In other words, although it’s extremely common for health providers to ask patients to sign written authorizations before disclosing health information, such written consent is not actually required by HIPAA.

Instead, a requirement for written consent usually reflects a clinic’s policies, or perhaps the preference of an individual clinician. Understandably, clinicians want to avoid HIPAA violations or otherwise being accused of failing to protect a patient’s confidentiality.

5 Caregiver FAQs about HIPAA and avoiding HIPAA violations

1. Is written permission always required by HIPAA, for a doctor to be able to talk to me about my older parent’s health?

Nope! As noted above, for permitted disclosures of health information, HIPAA does not require that a patient give written permission.

Instead, clinicians are allowed to use a patient’s verbal consent.

HIPAA also says it’s ok for clinicians to give patients an opportunity to object and to proceed if they don’t object, or even to “reasonably infer, based on professional judgment, that the patient does not object.”

Personally, I have often spoken to a patient’s adult children on the phone, because the patient told me it was okay to do so. However, I usually document in my clinical note that the patient said it was fine to talk to his or her children.

Last but not least, if a patient is not present or if it’s “impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person,” HIPAA says that clinicians can disclose information if they determine that doing so is in the best interest of the patient.

In short, HIPAA allows health providers to have a lot of leeway, when it comes to disclosing medical information to family and others. However, those disclosures will usually have to comply with the “minimum necessary” rule.

Most state laws are similar to HIPAA, but in some states, requirements may be more stringent.

You can find more details through these FAQs:

If I do not object, can my health care provider share or discuss my health information with my family, friends, or others involved in my care or payment for my care?

If I am unconscious or not around, can my health care provider still share or discuss my health information with my family, friends, or others involved in my care or payment for my care?

Does the HIPAA Privacy Rule permit a doctor to discuss a patient’s health status, treatment, or payment arrangements with the patient’s family and friends?

Do I have to give my health care provider written permission to share or discuss my health information with my family members, friends, or others involved in my care or payment for my care?

If the patient is present and has the capacity to make health care decisions, when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or others involved in the patient’s care or payment for care?

2. Can doctors talk to me about my older parent’s health during an emergency?

Yes, HIPAA allows this type of disclosure. So doctors are permitted to update you about your parent’s health during an emergency.

Furthermore, HIPAA does not require providers to ask family caregivers for proof of identity, before disclosing information.

That said, just because doctors are permitted to disclose information to you doesn’t mean they have to do it. As this FAQ notes, “a health care provider is not required by HIPAA to share a patient’s information when the patient is not present or is incapacitated, and can choose to wait until the patient has an opportunity to agree to the disclosure.”

For more information:

Does the HIPAA Privacy Rule permit a doctor to discuss a patient’s health status, treatment, or payment arrangements with the patient’s family and friends?

If the patient is not present or is incapacitated, may a health care provider still share the patient’s health information with family, friends, or others involved in the patient’s care or payment for care?

If my family or friends call my health care provider to ask about my condition, will they have to give my provider proof of who they are?

3. My older parent doesn’t want his doctor to talk to me. What can I do?

This question tends to come up when a family has become concerned about an older person’s mental and/or physical decline. Some older adults will resist their family’s desire to communicate with the doctor. So what can be done?

First of all, as a family member, remember that you are not a “covered entity.” So whether or not a doctor is permitted to disclose information to you, HIPAA does not prevent you from contacting your parent’s doctor and relaying any concerns or information you have.

You can even ask questions; the doctor probably won’t answer them, but it’s good for your parent’s doctor to know what kind of questions your family has.

Otherwise, if your parent has specifically told his doctor to not talk to you, then there are a couple of angles you can consider:

• Consider the possibility of incapacity. HIPAA does permit doctors to disclose information to family when a patient is incapacitated or otherwise unable to consent to the disclosure.
  • If you think your parent might be incapacitated by cognitive decline, delirium, or another medical problem, ask the doctor to consider this.
  • You can start by voicing concerns in a phone call, but it’s best to eventually put them in writing, because your letter will normally end up scanned into your parent’s medical chart. Be sure to include information on concerning behaviors of incidents that you have observed (such as any of these: 8 Behaviors to Take Note of if You Think Someone Might Have Alzheimer’s).
  • You can learn more about incapacity here: Incompetence & Losing Capacity: Answers to 7 FAQs
• Has anyone been designated as durable power of attorney for healthcare? HIPAA allows a patient’s representative to request medical records and health information.
  • Check any durable power of attorney documentation to see under what circumstances the agent has authority to act. Most documents require the older person to be incapacitated, but some allow the agent to act right away.

Of course, even if you are legally permitted to seek information about your parent’s health, your parent is likely to be angry about your doing so. The decision to override an older person’s decision or preferences is a serious one, and should only be considered under special circumstances.

If you have good reason to believe your parent’s insight and judgment are impaired, then it may be ethically reasonable to override their preference for privacy and take actions that will help them achieve their health and safety goals. Just be sure to think through the benefits and risks of your available options carefully, before you proceed.

Of course, what is better is that older adults plan ahead and tell their children what they should do if their older parent ever seems to be ill or mentally impaired, and refuses assistance. But as most older adults don’t get around to doing this, family caregivers do sometimes have to consider some difficult trade-offs when it comes to privacy versus health, safety, or other goals.

Relevant HIPAA FAQs and other information:

If the patient is not present or is incapacitated, may a health care provider still share the patient’s health information with family, friends, or others involved in the patient’s care or payment for care?

Under HIPAA, when can a family member of an individual access the individual’s PHI from a health care provider or health plan?

Incompetence & Losing Capacity: Answers to 7 FAQs

4. Does a power of attorney for healthcare give me the right to access my parent’s health information?

HIPAA gives a patient’s  authorized “personal representative” the right to access information and medical records. A personal representative is defined as a person authorized, under State or other applicable law, to act on behalf of the individual in making health care related decisions.

So yes, if you are the durable power of attorney for healthcare, then you will have a right to access your parent’s health information, provided you are currently authorized to act.

A power of attorney document should specify under what conditions the agent can act. Some are “springing,” which means the agent can only act if the “principal” (the person signing the document) is incapacitated.

But other durable power of attorney documents may allow the agent to have authority to act right away. In this case, you can act unless there is a conflict with what the principal says (assuming the principal has not been deemed incapacitated).

For more information:

Guidance: Personal Representatives

Individuals’ Right under HIPAA to Access their Health Information

Addressing Medical, Legal, & Financial Advance Care Planning

5. My parents want their doctors to share health information with me. How can we make sure the doctors do this?

The best approach is for your parents to bring this up with their doctors and ask what should be documented, to ensure this.

Even though HIPAA itself does not require patients to provide written authorization in order to disclose information to family, clinicians usually feel more comfortable disclosing information if the patient has put something in writing. Many clinics have forms available for this purpose.

Another thing to consider is having your parents designate you as durable power of attorney for health. Consider having your parent indicate that your authority is effective immediately, rather than upon incapacity. (This is an option on health POA forms in California.) This will confirm your status as their “personal representive,” when it comes to requesting access to their medical information.

For more information:

How can I help make sure my health care providers share my health information with my family, friends, or others involved in my care or payment for my care when I want them to?

More Useful HIPAA Resources

I’ve tried to cover the practical basics for caregivers in this article, but of course, there’s a lot more to HIPAA and medical privacy. 

Here are some of my favorite resources.

HIPAA Resource List

Your Rights Under HIPAA

A Patient’s Guide to the HIPAA Privacy Rule: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved In Your Care

HIPAA FAQs for Individuals

HIPAA FAQs for Professionals: Disclosures to Family and Friends

California Civil Code (regarding disclosures to family): CHAPTER 2. Disclosure of Medical Information by Providers

Individuals’ Right under HIPAA to Access their Health Information (Includes FAQs)

Next Step in Care Guide: HIPAA: Questions and Answers for Family Caregivers

Final Tips

Here are a few final tips for you to keep in mind, if you ever want to talk to a doctor about a relative’s healthcare.

• Plan ahead if possible.
  • Older people should consider how their family might be able to communicate with doctors in the event of an emergency, or even in the event of developing memory or thinking problems.
  • Find out how your family’s usual doctors and health providers will be most comfortable disclosing health information. Complete release of information forms ahead of time if possible.
  • Every older person should complete a durable power of attorney form for healthcare. Consider giving the agent authority to act immediately; this will enable the agent to request medical records even if the older person has not been proven to be incapacitated.
• Consider researching your state’s laws governing disclosure of health information to family and friends.
  • Many states have laws similar to HIPAA, but some may impose additional restrictions.
• Be prepared to politely help inform clinicians of what HIPAA permits. Some clinicians may not realize that HIPAA does allow them to talk to you about your relative’s health, depending on the circumstances.
  • Consider printing out a copy of the relevant HHS HIPAA FAQs for Professionals: Disclosures to Family and Friends.
  • For a good NPR story confirming that hospital employees and health providers often do NOT understand your access rights: It’s Your Right To See Your Medical Records. It Shouldn’t Be This Hard To Do.
  • Remember that although HIPAA permits clinicians to disclose information under many circumstances, such disclosures are not required. Clinicians are only required to disclose health information when a patient — or authorized representative — requests this, based on the patient’s right of access.

This article was last reviewed and updated in May 2026.